Direct Hemoperfusion Using Immobilized Polymyxin B in Patients with Rapidly Progressive Interstitial Pneumonias: A Retrospective Study

Abstract

Background: Rapidly progressive interstitial pneumonia (IP), including acute exacerbation of IP, has a high mortality rate. Direct hemoperfusion with a polymyxin B-immobilized fiber column (PMX-DHP) was recently identified as an effective treatment for sepsis-associated acute respiratory distress syndrome. However, little is known about the effectiveness of PMX-DHP for rapidly progressive IP. Objectives: The present study investigates whether PMX-DHP is safe and effective against rapidly progressive IP. Methods: We retrospectively examined the effects of PMX-DHP in 33 consecutive patients with rapidly progressive IP who were resistant to steroid pulse therapy. Patients were hospitalized at Nagasaki University Hospital between 2006 and 2009. Results: Seventy-two hours after PMX-DHP, the arterial oxygen tension/inspiratory oxygen fraction ratio (median 127–153 mm Hg) had significantly improved. One week after PMX-DHP, the arterial oxygen tension/inspiratory oxygen fraction ratio (median 127–227 mm Hg), the alveolar-arterial difference of oxygen (median 371–177 mm Hg) and the number of positive criteria for systemic inflammatory response syndrome had significantly improved, despite the ineffectiveness of corticosteroid pulse therapy. The serum level of monocyte chemotactic protein 1 was significantly decreased immediately after PMX-DHP. Conclusions: PMX-DHP was safe and effective in improving oxygenation and systemic inflammatory response syndromein patients with rapidly progressive IP. The beneficialeffects of PMX-DHP may be at least partially due to the inhibition of monocyte activation.

Effects of Direct Hemoperfusion with Polymyxin B-immobilized Fiber on Rapidly Progressive Interstitial Lung Diseases

“…Teruya et al described an ADM patient who developed rapidly progressive ILD with elevated anti-CADM-140 autoantibody was successfully treated with PMX-DHP after being resistant to combined steroid and immunosuppressant therapy (18). Hara et al reported that PMX-DHP would be a safe and effective therapy for rapidly progressive ILDs of different etiologies that were resistant to initial high-dose glucocorticoid therapy (8). In addition, Sato et al reported that a patient with severe amiodarone pulmonary toxicity was successfully treated with PMX-DHP and completely recovered (19).…”

“…Although the mechanisms by which PMX-DHP improves oxygenation in rapidly progressive ILD or acute exacerbations of IPF are unclear, various circulating molecules (i.e., monocyte chemotactic protein 1, metalloproteinase (MMP) -9, tissue inhibitor of MMP-1, neutrophil elastase, and IL-8) were decreased by the treatment (3,8,21). Oishi et al reported that the serum levels of cytokines, IL-9, IL-12, IL-17, PDGF, and VEGF significantly decreased immediately after PMX-DHP (22).…”

“…Abe et al reported that PMX-DHP might improve oxygenation and survival in IPF patients with acute exacerbation (7). In addition, it was also effective in improving oxygenation and systemic inflammatory response syndrome in patients with rapidly progressive interstitial lung diseases (ILDs) (8). However, all of the previous reports on the effects of PMX-DHP on acute exacerbations of IPF or rapidly progressive ILDs were case series without controls.…”

Serum heat shock protein 47 levels are elevated in acute exacerbation of idiopathic pulmonary fibrosis

“…Recently, direct hemoperfusion with a polymyxin Bimmobilized fiber cartridge (PMX-DHP) has been reported to have a beneficial impact on the respiratory status and long-term outcome of patients with AE-IPF (Seo et al 2006;Abe et al 2010;Enomoto et al 2008;Hara et al 2011). Oishi et al reported that proinflammatory, profibrotic, and proangiogenic cytokines, including TGF-β were eluted from PMX fibers used for the treatment of AE-IPF and suggested that adsorption of such cytokines onto PMX fibers might be one of the mechanisms of action involved.…”

Rapidly Progressive Interstitial Lung Disease Associated with Dermatomyositis Treated with Combination of Immunosuppressive Therapy, Direct Hemoperfusion with a Polymyxin B Immobilized Fiber Column and Intravenous Immunoglobulin

“…However, despite routine use of high dose corticosteroids and immunosuppressive agents, some cases are hard to treat. While some report the efficacy of direct hemoperfusion with a Polymyxin B immobilized fiber column (PMX-DHP) (3,4) and intravenous immunoglobulin (IVIG) (5), the efficacy and the safety of the PMX-DHP and IVIG combination are controversial. We herein report a case of rapidly progressive ILD associated with DM which survived with the administration of PMX-DHP and IVIG in addition to high dose corticosteroids and immunosuppressive agents.…”